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Each State's FY 2005 Medicaid data, submitted to CMS for reimbursement and
compiled by Thompson/Medstat, provides extremely helpful information to analyze
and compare your State's distribution of its Long Term Care expenditures
between its Institutional versus Community-Based Services.
Nationally, and for all disabilities, 63% of the long term care expenditures
went to institutions, i.e, both to nursing homes (for physically disabled
persons of all ages) and to intermediate care facilities (for persons with MR/DD).
37% went to the community, i.e., for all MA waivers (i.e., both PD and
MR/DD), personal care option, and home health services in the community.
As you all know, we live with the historical disability divide - persons with
MR/DD, on one hand, and persons with physical disabilities of all ages (i.e.,
aged, too) , on the other hand.As unfortunate as the divide is and as much
as it perpetuates divisions in the disability community,it's what we have.
MA expenditures follow this divide.
When disabilities are broken down by MR/DD and PD, a dramatic difference
exists in the 63-37% national long term care distribution.
For persons receiving MR/DD services, nationally only 41.6% goes to
institutions (ICF-MRs) and 58.4% is spent for community-based services.That is, less
Medicaid funds go to provide services for persons with MR/DD in the
institutions than in community.In dollars, $12.1 b was spent on institutions but $17 b
was spent for community-based services.
In contrast,for persons with physical disabilities (regardless of their
age), 72.9% is expended on institutional services and 27.1% on community-based
services.In dollars, nursing homes received $47 b but only $17.6 b was spent
for community-based services.
Why the lopsided distribution based on type of disability?
Are the MR/DD advocates better organized or smarter than the PD advocates?
Do MR/DD advocates have more clout at the State level?
Are MR/DD advocates more committed to community-based services?
Have they been engaged in this struggle for more years? [This is not to
suggest that 41.6% of the MR/DD services in institutions is satisfactory. To the
contrary, we hope they will increase the expenditure ratios for community-based
services. There is a long way still to go!]
Are the PD nursing home proprietors more politically powerful and connected
than the MR/DD ICF-MR private proprietors?
Why hasn't there even been a public discussion on the lopsided MR/DD versus
PD distribution? If you have any ideas, insights and are interested, send
your comments and we'll try to facilitate such a discussion.
Let's look at the differences in each State. The following chart provides two
columns - the first for MR/DD and the second for PD.For each, we provide
the ratio of expenditures, i.e., the amount of institutional expenditures for
each $1 of community expenditures.
The national ratio for MR/DD services is"0.71 in institutions for each
$1.00 expended in the community.
The national ratio for PD services is $2.68 in the institution for each $1
spent in the community.
How does your State compare?
Ratio of expenditures for institutional versus community:
| | MR/DD | PD |
| Alabama | 0.14 to $1 | $7.64 to $1 |
| Alaska | $0 to $1 | 0.93 to $1 |
| Arizona* | ?? | ?? |
| Arkansas | $1.60 to $1 | $2.85 to $1 |
| California | 0.62 to $1 | $1 to $1 |
| Colorado | 0.25 to $1 | $2.99 to $1 |
| Connecticut | 0 .51 to $1 | $3.65 to $1 |
| Delaware | $0.48 to $1 | $7.26 to $1 |
| D. C. | $7.81 to 1 | $4.52 to $1 |
| Florida | $0.49 to $1 | $7.23 to $1 |
| Georgia | $0.42 to $1 | $7.05 to $1 |
| Hawaii | $ 0.11 to $1 | $4.79 to $1 |
| Idaho | $1.11 to $1 | $1.51 to $1 |
| Illinois | $1.65 to $1 | $3.79 to $1 |
| Indiana | 0.82 to $1 | $11.93 to $1 |
| Iowa | $1.15 to $1 | $3.69 to $1 |
| Kansas | 0.31 to $1 | $2.17 to $1 |
| Kentucky | 0.70 to $1 | $4.61 to $1 |
| Louisiana | $1.73 to $1 | $5.54 to $1 |
| Maine | 0.30 to$1 | $3.33 to $1 |
| Maryland | 0.18 to $1 | $4.74 to $1 |
| Massachusetts | 0.33 to $1 | $3.35 to $1 |
| Michigan | 0.05 to $1 | $5.52 to $1 |
| Minnesota | 0.20 to $1 | $1.46 to $1 |
| Mississippi* | ?? | ?? |
| Missouri | 0.88 to $1 | $2.54 to $1 |
| Montana | 0.21 to $1 | $2.49 to $1 |
| Nebraska | 0.49 to $1 | $4.14 to $1 |
| Nevada | 0.55 to $1 | $2.63 to $1 |
| New Hampshire | 0.02 to $1 | $8.53 to $1 |
| New Jersey | $1.34 to $1 | $3.72 to $1 |
| New Mexico | 0.09 to $1 | $0.94 to $1 |
| New York | 0.81 to $1 | $1.85 to $1 |
| North Carolina | $1.56 to $1 | $1.39 to $1 |
| North Dakota | $1.12 to $1 | $18.98 to $1 |
| Ohio | $2.08 to $1 | $4.43 to $1 |
| Oklahoma | 0.55 to $1 | $3.20 to $1 |
| Oregon | 0 to $1 | 0.86 to $1 |
| Pennsylvania | 0.55 to $1 | $9.52 to $1 |
| Rhode Island | 0.04 to $1 | $8.13 to $1 |
| South Carolina | 0.89 to $1 | $4.54 to $1 |
| South Dakota | 0.29 to $1 | $8.66 to $1 |
| Tennessee | 0.76 to $1 | $91.04 to $1 |
| Texas | $1.91 to $1 | $1.18 to $1 |
| Utah | 0.51 to $1 | $9.31 to $1 |
| Vermont | 0.01 to $1 | $1.87 to $1 |
| Virginia | 0.78 to $1 | $3.74 to $1 |
| Washington | 0.36 to $1 | 0.95 to $1 |
| West Virginia | 0.29 to $1 | $3.29 to $1 |
| Wisconsin | 0.47 to $1 | $2.58 to $1 |
| Wyoming | 0.24 to $1 | $3.99 to $1 |
| National | 0.71 to $1 | $2.68 to $1 |
*Data for AZ and Mississippi are not available.
Steve Gold, The Disability Odyssey continues
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